A randomised comparative study of split thickness skin grafting fixation and uptake with use of autologous platelet rich plasma versus conventional method

Abstract

Skin grafting represents one of the oldest and most fundamental techniques in reconstructive surgery, with its first documented use dating back to ancient Indian civilization. The procedure has evolved significantly over centuries, yet remains a cornerstone in managing various soft tissue defects, whether arising from trauma, burns, chronic wounds, or surgical resections.1 Split-thickness skin grafts (STSGs), in particular, have emerged as a versatile and reliable option in reconstructive surgery, offering both functional and aesthetic restoration of skin defects.

The success of skin grafting procedures fundamentally depends on graft survival, which is influenced by multiple factors including the quality of the recipient bed, graft fixation techniques, and the complex biological processes that occur during graft take. Traditional methods of STSG fixation, including sutures, staples, and various dressing techniques, have shown varying degrees of success, with reported graft take rates ranging from 70% to 90% depending on the location and condition of the recipient site.2 However, these conventional approaches often face challenges such as graft displacement, seroma formation, and incomplete graft-to-bed contact, which can compromise graft survival.

The biological process of graft take involves a precise sequence of events beginning with plasmatic imbibition, followed by revascularization and eventually complete incorporation of the graft. This process is heavily dependent on the formation of a fibrin network between the graft and recipient bed, which not only provides initial adhesion but also serves as a scaffold for subsequent vascular ingrowth.3 The quality and efficiency of this initial phase significantly influence the ultimate success of the grafting procedure.